CMS intends to modify requirements for Meaningful Use

By Patrick Conway, MD

Today, we at the Centers for Medicare & Medicaid Services (CMS) are pleased to announce our intent to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2015. These intended changes would help to reduce the reporting burden on providers, while supporting the long term goals of the program.

Since the first year of the EHR Incentive Programs in 2011, the United States has seen unprecedented growth in the adoption and meaningful use of EHRs. To date, more than 400,000 eligible providers have joined the ranks of hospitals and professionals that have adopted or are meaningfully using EHRs. This means that millions of patients across the nation are benefiting from the potential of better coordinated care among professionals, more accurate prescribing, and improved communication.

The new rule, expected this spring, would be intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015. It would also be intended to propose changes reflective of developments in the industry and progress toward program goals achieved since the program began in 2011.

We are considering proposals to:

• Realign hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs.
• Modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.
• Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes.

To clarify, we are working on multiple tracks right now to realign the program to reflect the progress toward program goals and be responsive to stakeholder input. Today’s announcement that we intend to pursue the changes to meaningful use beginning in 2015 through rulemaking, is separate from the forthcoming Stage 3 proposed rule that is expected to be released by early March. CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years. 

These changes reflect the Department of Health and Human Services’ commitment to creating a health information technology infrastructure that elevates patient-centered care, improves health outcomes and supports the providers who care for patients. We continuously strive to work in partnership with providers to improve affordability, access, and quality.

For more information about the EHR Incentive Programs, please visit HTTP://www.cms.gov/EHRIncentivePrograms.

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Moving forward on primary care transformation

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer 

Today, we at the Centers for Medicare & Medicaid Services (CMS) are excited to announce the promising findings from two large-scale tests of advanced primary care: the Comprehensive Primary Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration. The CPC initiative, in its first year, decreased hospital admissions by 2% and emergency department visits by 3%, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS. The MAPCP Demonstration generated an estimated $4.2 million in savings through the use of advanced primary care initiatives.

These two programs are part of broader efforts to deliver better care, spend dollars more wisely, and have healthier people and communities.

Comprehensive Primary Care initiative

With authority from the Affordable Care Act, the CPC initiative is a unique multi-payer partnership between Medicare, Medicaid private health care payers, and primary care practices in four states (Arkansas, Colorado, New Jersey and Oregon) and three regions (New York’s Capital District and Hudson Valley, Ohio and Kentucky’s Cincinnati-Dayton region, and Oklahoma’s Greater Tulsa region). This initiative includes providing care management for those at greatest risk; improving health care access; tracking patient experience; coordinating care with hospitals and specialists; and using health information technology to support population health. Practices receive non-visit based care management fees from the participating payers, and the opportunity to share in savings.

In the first year, 492 practices participated, serving about 345,000 Medicare beneficiaries and more than 2.5 million patients overall. Results from this first year suggest that CPC has generated nearly enough savings in Medicare health care expenditures to offset care management fees paid by CMS.

• The primary sources of the savings were reduced rates of hospital admissions and emergency department visits.
• The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients.
• Over 90 percent of practices successfully met all first-year transformation requirements.
• The expenditure impact estimates differ across the seven regions.
• Additional time and data are needed to assess impact on care quality.

Results should be interpreted cautiously as effects are emerging earlier than anticipated, and additional research is needed to assess how the initiative affects cost and quality of care, beyond the first year. Because the effects of the CPC program are likely to be larger in subsequent years, these early results are consistent with the possibility that the model will eventually break-even or generate savings.

Multi-payer Advanced Primary Care Practice Demonstration

The MAPCP Demonstration is multi-payer initiative in which Medicare is participating with Medicaid and private health care payers in eight advanced primary care initiatives in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont. Unlike CPC, the states convene the participants and administer the initiatives rather than CMS. Under this demonstration, participating practices and other auxiliary supports (e.g., community health teams) receive monthly care management fees from the participating payers and additional support (e.g., data feedback, learning collaboratives, practice coaching).

More than 3,800 providers, 700 practices, and 400,000 Medicare beneficiaries participated in the first year. During the first year, the demonstration produced an estimated $4.2 million in savings. Also, the rate of growth in Medicare FFS health care expenditures was reduced in Vermont and Michigan, driven largely by reduced growth in inpatient expenditures. There is less evidence that the state initiatives were able to reduce hospitalization, readmission and emergency department visit rates. Additional findings in this evaluation period include:

• The MAPCP payments provided needed support to help practices transform the way they deliver and coordinate care, including use of nurse care managers or care coordinators, restructuring of staff, improvements in patient flow, adoption of health information technology, and more frequent staff meetings.
• Medicare was able to integrate seamlessly with the structure and organization of the eight state initiatives. Medicare’s participation sent a strong signal about the importance of primary care and the potential of these programs, helping to affirm payer and provider commitments.
• Although collecting and using data was a recurring challenge, health information systems facilitated the transformation process.

These first-year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities. CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care.

Additional

• Comprehensive Primary Care Initiative
  • First Evaluation Report

 

• Multi-payer Advanced Primary Care Practice Demonstration
  • First Evaluation Report